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After starting dialysis treatment, patients often centralize their care in the dialysis center or with the nephrologist, restricting the advance care planning to the renal dysfunction and its complications. Therefore, aspects of the health of women who have CKD, such as gynecological cancer screening and reproductive and sexual health are neglected. This abstract aims to characterize the women's health-related primary care delivery for women undergoing hemodialysis.
This is a quantitative, descriptive study, conducted as a population-based survey using structured interviews. We evaluated patients over 18 years old with CKD undergoing hemodialysis in three dialysis centers located in the state of Paraíba, Brazil.
A total of 80 women were interviewed, with a mean age of 50,91 years (SD: 13.65) and an average dialysis duration of 34.85 months (SD: 35.41). Out of the target population for cervical cancer screening (n = 61), 8 (13.1%) had never undergone the exam. Among those who underwent the screening, only 40 (65.6%) had it within the last 3 years. 18% of those interviewed confirmed that the nephrologist discussed the need for regular cervical cancer screening. Regarding mammography, approximately 63% of women of suitable age for screening underwent the radiographic examination at least once and only 37.9% did so at an appropriate frequency (annual or biennial). Only one reported receiving guidance from the nephrologist about the need for periodic mammography. 65% of the patients reported that they had already undergone gynecological examination, but only 20% did it annually. Only 7.5% reported that the nephrologist questions and is interested in gynecological evaluation. Approximately 29% of respondents reported having been questioned by a physician about gynecological or urological symptoms. Among women aged 25 to 49, 36.6% reported receiving guidance on contraception, family planning, and gestational risks, however, only 13.3% were approached by a nephrologist on this topic. Within this age group, around 73% of those interviewed attributed the responsibility for women's health to the gynecologist, but only 56.66% carried out follow-up care with the specialist. Only 10 interviewees (13.2%) were asked by a physician about a decrease in sexual interest. Between the ages of 50 and 74, 78.26% believed the gynecologist was responsible for reproductive and gynecological health, but only 10% were monitored by such a professional. Most women not receiving specialized care indicated difficulty in access as the biggest barrier for this to happen.
Cervical and breast cancer screening is performed by the patients, but not with the frequency recommended by the World Health Organization. A significant percentage of the patients do not receive guidance regarding contraception, family planning, and pregnancy risks from their nephrologists. Women undergoing hemodialysis identify the gynecologist as being responsible for their reproductive health, but access difficulties prevent them from receiving care from this specialist. Nephrologists tend not to inquire and inform patients about sexual dysfunctions, gynecological conditions, or other women's health-related primary care.